Vaccines HPV Vaccine Gardasil 9 for Boys By Lisa Fayed Lisa Fayed is a freelance medical writer, cancer educator and patient advocate. Learn about our editorial process Lisa Fayed Medically reviewed by Medically reviewed by Anju Goel, MD, MPH on April 21, 2021 linkedin Anju Goel, MD, is board-certified in internal medicine. She has over 10 years of experience in the California public health system addressing communicable disease, health policy, and disaster preparedness. Learn about our Medical Review Board Anju Goel, MD, MPH Updated on April 29, 2021 Print Table of Contents View All Table of Contents Rationale HPV in Boys Recommendations Side Effects Gardasil-9 is a vaccine that protects against human papillomavirus (HPV), a virus that is spread through sexual contact. HPV vaccination prevents nine high-risk types of HPV linked to cancer, most predominately cervical cancer but also cancer of the anus, vagina, vulva, penis, mouth, tonsils, and throat. Gardasil-9 replaced the original HPV vaccine, Gardasil-4, in 2017. FangXiaNuo / Getty Images When the original Gardasil was first approved by the U.S. Food and Drug Administration (FDA) in 2006, it was recommended for girls and women ages 9 to 26 only. It was only in 2009 that the recommendations were expanded to include boys and men 9 to 26. In 2018, the FDA further expanded its recommendation so that men and women ages 27 to 45 can opt for HPV vaccination after consultation with a physician. Gardasil-9 is today the only HPV vaccine approved for use in the United States following the voluntary discontinuation of Cervarix (which protected against two HPV types) in 2016. Are HPV and Genital Warts the Same Thing? Rationale The FDA and Centers for Disease Control and Prevention (CDC) decided to extend the use of Gardasil to boys based on studies that showed that HPV increases the risk of anal cancer by 17- to 20-fold in men and women and that the risk in men who have sex with men (MSM) may be increased by as much as 70-fold. Moreover, over 30% of penile cancers are known to be linked to two specific HPV types, type 16 and type 18. These are two of the types targeted by Gardasil-9 and the ones linked to the majority of cervical cancers, anal cancers, and other HPV-associated cancers. What's more, the virus is spread through sexual contact, which means that a male who is infected with HPV can pass it to another male or female. By preemptively vaccinating boys before they are sexually active, the spread of infection can be reduced along with a boy's risk of anal, penile, and oropharyngeal (mouth and throat) cancer in later life. Gardasil 9 protects against seven high-risk types of HPV associated with cancer (types 16, 18, 31, 33, 45, 52, and 58) and two low-risk types associated with genital warts (types 6 and 11). 10 Facts You May Not Know About HPV HPV Infection in Boys According to the CDC, an estimated 79 million people in the United States are infected with HPV. There are over 200 types of HPV, 40 or so of which are sexually transmitted. The majority do not cause cancer, and some cause no symptoms at all. Genital Warts A handful of low-risk HPV types are responsible for genital warts, of which 90% are linked to HPV types 6 and 11. In males, warts may occur on the penis, scrotum, testicles, anus, groin, or thighs. In most cases, genital warts pose no major health risks, although they may be unsightly and embarrassing. Some will resolve on their own; others may require medical treatment to remove them (although recurrence is common). Cancer However, the types of HPV that can cause genital warts are not the same as the types that can cause cancer. Most people who become infected with these do not know that they have been infected. These high-risk types, referred to as oncogenic HPV, can sometimes linger and cause normal cells to turn cancerous—although it is not entirely clear why. While the type of HPV plays a large role in this, so can co-occurring conditions like HIV, which is already linked to an increased risk of many types of cancer. In men with HPV and HIV, the incidence of anal cancer is roughly 78 per 100,000 compared to only 2 per 100,000 in the general population. Some studies have suggested that the rate may be as high as 168 per 100,000. Treating HIV and Human Papillomavirus Recommendations The CDC recommendations for HPV vaccination are the same for boys and girls. The ideal age to receive Gardasil-9 is between 11 and 12, when most people are not yet sexually active. It can be given to individuals as young as 9 who make be at risk of sexual exposure. Anyone up to the age of 26 should also be vaccinated if they have not previously done so or have not completed the recommended series. Even so, vaccination during the preteen years is preferred as people are less likely to have been exposed to the virus and generally have a better immune response. HPV vaccination is highly effective in people who have not been exposed to the HPV types that Gardasil-9 protects against. It may be less effective in those with risk factors for HPV, including adults with multiple lifetime sex partners. The recommended dosage of Gardasil-9 varies by age. Group Dose Schedule Ages 9 to under 15 2 •First dose ideally between 11 and 12 •Second dose 6 to 12 months later Ages 15 to 26 3 •First dose •Second dose 1 to 2 months later •Third dose 6 months after the first dose Ages 27 to 45 3 Same as for 15- to 26-year olds It is important to note that while the FDA approved HPV vaccination in people ages 27 to 45, the CDC recommends "shared clinical decision-making" regarding HPV vaccination in this age group. This is because is benefits of vaccination may be low given that the majority of people will have already gotten HPV by the time they are 27. By discussing your medical and sexual history with your doctor, you can decide whether HPV vaccination is appropriate. According to the CDC, HPV is so common that nearly all sexually active men and women will get the virus at some point in their lives. Why Don't More American Teens Get the HPV Vaccine? Side Effects In clinical trials, Gardasil-9 was found to be safe and effective, although it may cause mild, transient side effects in some people, including: Pain, redness, or swelling at the injection site Fever, usually mild Nausea Dizziness Headaches Muscle or joint pain Gardasil-9 should not be used by anyone who has had a hypersensitive reaction to a prior dose of the vaccine. Benefits and Side Effects of the HPV Vaccine A Word From Verywell HPV is the most common sexually transmitted infection in the United States. While HPV will usually go away on its own, this shouldn't suggest you should take any chances with your child. Unlike most vaccines recommended by the CDC, HPV vaccination is mandated by only a small handful of states. In fact, as of 2020, only Hawaii, Rhode Island, Virginia, Washington, D.C., and Puerto Rico required HPV vaccination in school children. It, therefore, leaves it up to you as a parent to get your child vaccinated if your state or school does include Gardasil-9 on its vaccine schedule. How to Pay for Gardasil-9 If You Can't Afford It Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Merck & Co. Package insert - Gardasil 9. Updated August 2020. Centers for Disease Control and Prevention. Gardasil-4 is no longer available. May 8, 2017. Centers for Disease Control and Prevention. FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Week Rep. 2010;59(2):630-2. U.S. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years olds. October 05, 2018 Berry JM, Jay N, Cranston RD, et al: Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men. Int J Cancer. 2014;134:1147-55. doi:10.1002/ijc.28431 Patel P, Bush T, Kojic EM, et al. Prevalence, incidence, and clearance of anal high-risk human papillomavirus infection among HIV-infected men in the SUN study. J Infect Dis. 2018;217(6):953-963. doi:10.1093/infdis/jix607 Kidd LC, Chaing S, Chipollini J. Relationship between human papillomavirus and penile cancer—implications for prevention and treatment. Transl Androl Urol. 2017 Oct 6(5):791-802. doi:10.21037/tau.2017.06.27 Chaturvedi AK. Beyond cervical cancer: burden of other HPV-related cancers among men and women. J Adolesc Health. 2010 Apr;46(4 Suppl):S20-6. doi:10.1016/j.jadohealth.2010.01.016 Centers for Disease Control and Prevention. Basic information about HPV and cancer. Updated September 3, 2020. Centers for Disease Control and Prevention. Human papillomavirus (HPV) infection. Updated June 4, 2015. Blaser N, Bertisch B, Kouyos RD, et al. Impact of screening and antiretroviral therapy on anal cancer incidence in HIV-positive MSM. AIDS. 2017;31:1859-66. doi:10.1097/QAD.0000000000001546 Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:698-702. doi:10.15585/mmwr.mm6832a3 Centers for Disease Control and Prevention. Human papillomavirus (HPV) statistics. Updated January 25, 2021. National Conference of State Legislatures. HPV vaccine: state legislation and regulation. Updated May 26, 2020